Applied Epidemiology in Cardiovascular Disease and in COVID-19 in Queensland, Australia

Abstract

Between February 2017 and June 2021, I undertook the Master of Philosophy in Applied Epidemiology at the Australian National University. During this period, I was employed as a cardiologist at the Sunshine Coast University Hospital in Queensland Health. My thesis presents the results of the four required field research projects. Acute Public Health Problem: The ATHENA COVID-19 Study: Part 1 - data linkage study of outcomes in people diagnosed with COVID-19 in Queensland 1 January to 31 December 2020. Part 2: linkage of general practitioner (GP) data and consent-to-recontact. The aim of Part 1 was to describe health outcomes and investigate predictors of outcomes for all people diagnosed with COVID-19 in Queensland by linking COVID-19 notification, hospital, general practice and death registry data. The aim of Part 2 was to establish a readily available and ongoing resource for access to COVID-19 patients' health care data and to the patient themselves, enabling biospecimen-related research including the study of long-COVID. The findings from Part 1 were consistent with what is known about COVID-19. This work reinforced the value of linking multiple data sources to enhance reporting of outcomes for people diagnosed with COVID-19 and provide a platform for longer term follow up. Part 2 demonstrated that the majority of COVID-19 patients are willing have their health care data, including that from general practices, used for research. They are also agreeable to being recontacted to discuss participation in COVID-19 related research. The ATHENA COVID-19 database will form a valuable future resource for research into COVID-19. Evaluation of a Surveillance System: The evaluation of Pen Computing System Population Aggregation Tool as a potential surveillance system for monitoring cardiovascular disease risk scores and appropriateness of treatment, for the Australian population. The Population Aggregation Tool Clinical Audit Tool (PAT CAT) produced by Pen Computing Systems, is widely available to Primary Health Networks across Australia, and has the capability to monitor cardiovascular disease (CVD) risk scores and treatment undertaken by GPs. This work 1) evaluated whether PAT CAT could be used as a surveillance system for monitoring absolute CVD risk scores and appropriateness of treatment 2) provided recommendations for improvement and 3) initiated actions to enable improvements. Epidemiological Project: A cross-sectional survey describing general practitioners' absolute cardiovascular disease risk assessment practices and their relationship to knowledge, attitudes and beliefs about cardiovascular disease risk in Queensland, Australia. This study described GPs absolute cardiovascular disease risk (ACVDR) self-reported assessment practices and their relationship to knowledge, attitudes and beliefs about ACVDR. The findings were although the majority of GPs report using the ACVDR calculator when undertaking an ACVDR assessment, there is a need to increase the actual proportion of eligible patients undergoing ACVDR assessment. This may be achieved by improving GP assessment practices such as GP and patient knowledge of cardiovascular disease risk, providing sufficient time and nurse-led assessment. Data Analysis: Prevalence of coronary microvascular dysfunction (CMD) in patients being investigated for chest pain in an outpatient setting, and association with typical angina symptoms: a cross-sectional study. This project demonstrated that a third of patients referred to clinics with chest pain and normal coronary arteries have CMD. Global (whole of myocardium) CMD was not associated with typical angina but the presence of CMD in the right coronary artery territory was associated with angina in both males and females. This strength of this association was similar in men and women. In the thesis I also provide evidence of presentations conducted at national conferences and teaching exercises to colleagues.